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Covid-19 Primary Care Resources

Covid antibody and antiviral treatments

second antiviral

A summary of currently available treatments, eligibility criteria and how to refer

This information is sourced from PULSE and NHSE

Currently available therapeutics

Neutralising monoclonal antibody (nMAB) drugs

nMABs are an intravenous treatment option for non-hospitalised adults and children (aged 12 years and above) in the highest risk cohorts

Sotrovimab (brand name Xevudy)

  • dual-action nMAB; blocks viral entry into healthy cells and clears cells infected with SARS-CoV-2
  • given within 5 days of symptom onset
  • recommended dose is 500mg to be administered as a single intravenous infusion

Antiviral treatment

Where treatment with an nMAB is contra-indicated or not feasible, eligible patients may be offered an antiviral as an alternative

Molnupiravir  brand name Lagevrio)

  • inhibits viral replication
  • given within 5 days of symptom onset
  • is given orally as a five-day course

Inclusion criteria

  • SARS-CoV-2 infection confirmed by PCR testing within the last 5 days
  • AND onset of symptoms of Covid-19 within the last 5 days
  • AND a member of a ‘highest’ risk group – see table below

Patient cohorts considered at highest risk from Covid-19 eligible for treatment with nMAB or antivirals

Patients eligible for treatment with nMAB or antivirals

The following high-risk patients will be eligible for treatment:

  • Down’s syndrome and other genetic conditions that might reasonably be expected to reduce immune competence
  • Patients with a haematological diseases and stem cell transplant recipients
  • Solid cancers, or patients who have received radiotherapy within the last six months or chemotherapy within the last 12 months
  • Certain patients with a haematologic malignancy – eg, those within 12 months of a stem cell transplant, who have active graft vs host disease or who are within 3-6 months of various therapies
  • Renal disease including those with a transplant (or a failed transplant within the last 12 months), all those with CKD 4 or 5 and those who have had B cell depleting therapy in the past 12 months or are otherwise immunosuppressed
  • Liver disease including cirrhosis, transplant and immunosuppression due to therapy for liver disease
  • Immune mediated inflammatory disorders, including immunosuppression due to medication
  • Primary immune deficiencies
  • HIV or AIDS where the viral load is high or the CD4 count is <350 cells/mm3 (or > cells/mm3 that with additional risk factors)
  • Recipients of solid organ transplants not covered in other categories
  • Neurological conditions – multiple sclerosis, motor neurone disease, myasthenia gravis and Huntington’s disease

These criteria are being regularly updated here

Exclusion criteria

  • Clinical presentation indicates recovery rather than risk of deterioration from infection
  • Require hospitalisation or supplemental oxygen for Covid-19
  • Children weighing less than 40kg
  • Children aged under 12 years
  • Known hypersensitivity reaction to the active substances or excipients

Accessing treatment

  • Most of the highest risk patients will receive a letter or email telling them in advance they may be eligible for these treatments in the event they test PCR positive for Covid-19
  • They will also automatically receive a priority PCR test to keep at home
  • The public are advised to call 119 if they think they may be eligible for treatment but have not received a test kit by 10 January 2022
  • Eligible patients should then be contacted by their local Covid Medicine Delivery Unit (CMDU) if they have a positive PCR test
  • If an eligible patient is not contacted by their local CMDU within 24 hours of a positive PCR test GPs should refer them urgently

How GPs can refer

  • via e-RS under the ‘Infectious Diseases’ specialty and clinic type ‘Not otherwise specified’ to Covid Medicine Delivery Unit (CMDU)
  • Include patient details, the date of the PCR test, and the condition(s) that you think might make them eligible for treatment

Other at risk groups not currently eligible for treatment

Oral antivirals are also available to a wider cohort of at-risk patients through a national study known as PANORAMIC. Patients can join the PANORAMIC study if they:

  • have been unwell with Covid-19 for less than five days
  • have a recorded positive PCR test within the past seven days
  • are aged 50 and over
  • or aged between 18 to 49 years with underlying health conditions that make them clinically more vulnerable (list of conditions is on this panoramic participant information link)

See also

National CMDU Directory

Patient Information on antibody and antiviral treatment for Covid-19

Written by Dr Poppy Freeman